背景:在当前的数字时代,eHealth素养在非传染性疾病(NCDs)老年人的医疗保健和自我管理中起着不可或缺的作用。适当,准确地衡量电子健康素养,确保成功实施和评估相关研究和干预措施。然而,现有的电子健康素养措施主要侧重于个人获取和理解电子健康信息的能力(Web1.0),而基于网络的交互(Web2.0)和使用eHealth信息(Web3.0)的功能尚未得到充分评估。
目的:本研究旨在检验可靠性,有效性,在患有非传染性疾病的老年人中,电子健康素养量表-Web3.0(eHLS-Web3.0)的测量不变性。
方法:在基线评估中招募了642名患有非传染性疾病的中国老年人(平均年龄65.78,SD3.91岁;55.8%为女性),其中134人(平均年龄65.63岁,SD3.99岁;58.2%为女性)完成了1个月的随访评估。基线测量包括中文版的24项3DeHLS-Web3.0,中文版的8项一维电子健康素养量表(eHEALS),和人口统计信息。后续措施包括24项eHLS-Web3.0和加速度计测量的身体活动和久坐行为。一系列的统计分析,例如,Cronbachα,复合可靠性系数(CR),验证性因子分析(CFA),和多组CFA,进行检查内部一致性和重测可靠性,以及结构,并发,convergent,判别式,和预测效价,以及eHLS-Web3.0跨性别的测量不变性,教育水平,和居住。
结果:Cronbachα和CR分别在0.89-0.94和0.90-0.97的可接受范围内,表明eHLS-Web3.0及其子量表具有足够的内部一致性。eHLS-Web3.0还展示了跨时间稳定性,基线和随访指标显示出显着的组内相关性为0.81-0.91。eHLS-Web3.0的3D结构模型的结构效度得到验证性因素分析的支持。eHLS-Web3.0表现出收敛有效性,平均方差提取值为0.58,CR值为0.97。CFA结果支持了结合3个eHLS-Web3.0子量表和eHEALS的拟议4因素模型的判别有效性。eHLS-Web3.0对健康行为的预测有效性得到了eHLS-Web3.0与轻度体力活动的显着关联的支持(β=.36,P=.004),中等至剧烈的体力活动(β=.49,P<.001),和久坐行为(β=-.26,P=.002)。最后,eHLS-Web3.0跨性别的测量不变性,教育水平,住宅得到了配置的支持,公制,坚强,严格的不变性。
结论:本研究为可靠性提供了及时的经验证据,有效性,和eHLS-Web3.0的测量不变性,这表明24项3DeHLS-Web3.0是衡量Web3.0领域内非传染性疾病老年人电子健康素养的适当且有效的工具。
BACKGROUND: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals\' abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated.
OBJECTIVE: This study aimed to examine the reliability, validity, and
measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs.
METHODS: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the
measurement invariance of the eHLS-Web3.0 across gender, education level, and residence.
RESULTS: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=-.26, P=.002). Finally, the
measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances.
CONCLUSIONS: The present study provides timely empirical evidence on the reliability, validity, and
measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere.